As many as 3 million Americans, the vast majority of them undiagnosed, have a condition known as celiac disease. Celiac disease may be one of the least known but more common diseases, as it actually affects more Americans than epilepsy (2.8 million), Alzheimer’s disease affects (2 million), and multiple sclerosis (350,000). Celiac disease is also sometimes known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy.

Celiac disease is a genetic disorder that results in a sensitivity to gluten, a protein found in wheat, rye or barley products. The condition causes an autoimmune response to gluten, and the immune system responds by damaging the small intestine. When untreated, the chronic inflammation and damage to the small intestine prevents absorption of needed vitamins and minerals, which can leave sufferers anemic and malnourished.

Over time, untreated celiac disease can lead to other serious health problems, including autoimmune diseases, thyroid conditions such as Hashimoto’s and Graves’, Type 1 diabetes, rheumatoid arthritis, lupus, liver disease, infertility and even intestinal, bowel and lymphatic cancers.

Celiac disease is actually one of the only “curable” causes of autoimmune thyroid disease. For some thyroid patients, after celiac disease is properly diagnosed and treated, the resulting thyroid condition actually disappears.

Despite the substantial risks of celiac disease, it typically takes around a decade or more for someone with the disease to get properly diagnosed. And only a small percentage of celiac disease sufferers — some experts estimate no more than 3% — are actually being treated. Why? Because doctors and the general public are both relatively unaware of celiac disease, and symptoms can be vague and hard to pinpoint.

SYMPTOMS

While some people with celiac disease can have the condition without any symptoms, the classic symptoms include:

Conditions that are more common in celiac patients — and therefore should raise the index of suspicion — include anemia, osteoporosis, osteopenia, infertility and chronic hepatitis.

DIAGNOSIS

The best practitioner to see for diagnosis and treatment of celiac disease is a gastroenterologist. While symptoms may suggest allergy, allergists typically don’t conduct the tests needed to diagnose celiac disease.

To make a diagnosis, the gastroenterologist typically runs a set of tests, sometimes referred to as a “Celiac Panel.” These tests will usually look at various antibodies, and in particular, anti-gliadin antibodies.

Confirmation of the diagnosis usually involves an intestinal/small bowel biopsy performed by endoscopy. In this procedure, a small piece of tissue is removed and evaluated under a microscope, looking for the typical damage done by celiac disease.

TREATMENT

While celiac disease itself has no cure, it can be effectively controlled by strictly eliminating all gluten — found in wheat, rye and barley products — from the diet. The gluten-free diet must be maintained for life, and eating even a small amount of gluten can trigger symptoms and trigger intestinal damage.

This diet can naturally be a challenge. Basically, most grain, pasta, cereal, and many processed foods must be avoided. Even cross contamination of approved foods with gluten-containing foods can be a problem. Luckily, more stores — especially organic food stores, health food stores, and Internet vendors — are now carrying gluten-free bread, pasta, and other products.

For most people, following the gluten-free diet will stop symptoms, heal the existing intestinal damage, and prevent further damage. And improvements are almost immediate, with complete healing of the small intestine usually complete within 3 to 6 months in children and younger adults, and 2 years for adults.

NOTE: Especially for Thyroid Patients

If you have autoimmune hypothyroidism, you have a much higher risk than others of having celiac disease. Screening for celiac disease, however, is unfortunately not commonly done for hypothyroid patients who don’t have obvious celiac symptoms. If you are taking thyroid medication, and still suffering symptoms, you may want to explore the possibility of celiac disease with your practitioner. Physicians are now recognizing that undiagnosed celiac disease may cause levothyroxine malabsorption — an inability to absorb thyroid medicine that leaves patients hypothyroid, despite taking higher than expected doses of thyroid medication.

Researchers are now recommending that that the diagnosis of celiac disease should always be considered in patients requiring higher than expected doses of thyroid hormone replacement, including in thyroid patients who have no symptoms or other apparent manifestations of the disease.

To Find Out More

NIH Celiac Information Center

The Celiac Disease Center at Columbia University

(August 2006)

Mary Shomon is an internationally-known thyroid patient advocate, and is author of a number of best-selling health books, including Living Well With Hypothyroidism and The Thyroid Diet. Since 1997, she has run the Internet’s most popular thyroid patient sites: About.com Thyroid Site and Thyroid-Info.com